Tuesday, February 06, 2007

The ACE Study

One of my colleagues shared some results of a strikingly poignant study with me today. The ACE Study is an on-going collaborative effort between Kaiser Permanente's Department of Preventive Medicine and the Centers for Disease Control and Prevention. The study posed the question of whether, and how, childhood experiences affect adult health decades later.

Involving 17,421 adults in San Diego, the findings "indicate a powerful relationship between our emotional experiences as children and our physical and mental health as adults, as well as the major causes of adult mortality in the United States", according to an article published by Dr. Vincent J. Felitti, MD. The study "documents the conversion of traumatic emotional experiences in childhood into organic disease later in life." The authors conclude that one does not just "get over things"---the effects reverberate for decades.

Looking at the population with whom we work, it makes perfect sense that our patients---burdened by childhood trauma of often unspeakable ugliness---manifest illness as adults as a direct result of what occured when they were helpless and innocent children. Obesity, COPD, addiction, intravenous drug use, emotional disorders---all are unequivocally linked to early childhood trauma. Similarly, occupational health and job performance as adults were equally shown to be strongly tied to negative childhood experiences. Perfect sense, indeed.

Just today I was confronted with a patient whose drug abuse and emotional distress is a direct result of childhood sexual abuse and molestation. I sat this morning in another patient's kitchen as she recounted for me the physical and emotional abuse she endured throughout her life and the way in which it has destroyed her chances of recovery. A third patient blinds himself with alcohol, denying all the while that it's a problem. His wife sits stonily across the room, her arms crossed tightly, eyes flashing with anger when she knows he's lying to me. What happened to him when he was a child? What abuse did she suffer? How can they escape its grasp?

Evaluating what this study means is daunting. If childhood abuse and trauma are directly correlated with adult morbidity and mortality, doesn't this underscore the fact that we have a public health crisis of epic proportions on our hands? As we vaccinate, evaluate growth charts, weigh, examine vision, check hearing and screen for scoliosis, is there something even more crucial which we're missing in our children and teenagers? For every vaccination record we conscientiously complete, is there undue suffering which we completely overlook? How do we see the signs? We can look for overt bruises and screen for depression, but many children will mask the effects of such abuse under layers of disassociation. A monumental task then looms: how to properly screen for these certain causes of morbidity and mortality?

The effects of trauma seem almost ubiquitous to me as I go about my work. And as mental healthcare is continually treated as a second-class issue in this country as compared to physical health---especially where prevention is concerned---I wonder how we, as a society, will learn to cope. As health plans emasculate mental health coverage to cut costs, "short-term therapy" becomes the only recourse, and we all know that the effects of trauma cannot be "cured" in eight sessions, perhaps not even in eighty sessions. As I mentioned above, we can screen a child's vision and hearing ad nauseum, but if we miss the subtle signs that they're being abused at home, our preventive healthcare is merely a shell of its potential reality.

As I delve deeper into the ACE study, I may bring my gleanings of that material to bear here on Digital Doorway. In the interest of humanity as a whole, I suggest we all take a good hard look at what this study is trying to communicate to us. But that is only the beginning. After we realize the truth of what we see, it will only beg the question: what now? And the future may depend on our answer.
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